A migraine is probably the most severe headaches you can have. It is a type of vascular headache (vascular means “related to blood vessels”). Migraines can occur at all ages. They affect about one person in ten, women more then men, and often run in families.
They typically occur during hormonal changes, such as in adolescence, though you can have them unpredictably at any time. Women find that the attacks are worse around menstruation and they lessen in frequency and intensity during pregnancy and after menopause.
TYPE OF MIGRAINE
Common migraine: This is the typical migraine. It consists of throbbing pain on one side of the head, in the temple are or behind one eye. You may become nauseated and may even vomit. It may last anywhere from six hours to three days. Noise, movement, and bright light generally make the pain worse.
Classic migraine: Less common; similar to a common migraine except that before the headache starts you have a strange symptom called an aura. An aura can take various forms; a vague uneasiness or anxiety (a feeling that something is about to happen), nausea, dizziness, or numbness or tingling in the limbs. Some auras are visual and can be seen with your eyes open or closed. The most common visual aura is a zigzag pattern of pulsating lights. A portion of your vision may disappear for a few minutes.
Auras are probably caused by sudden spasms of blood vessels in the brain. The specific aura symptoms depend on the location of those blood vessels.
Cluster headache: (also called a Horton’s or a “histamine” headache).
Recurs a number of times over a few weeks or months, sometimes starting at the same time of the day or night, followed by long periods of freedom. It tends to cause a stabbing pain in or around one eye, which can be severe enough to awaken you from sleep. It typically lasts for about an hour, but can go on for as long as several days. This attack may be accompanied by a runny nose on one side, a red eye, and sometimes a drooping eyelid.
Ophthalmic migraine: The affected blood vessels are those providing circulation to the eye. Symptoms can include a temporary loss of vision and visual auras. This type of migraine is not usually associated with a headache.
Ophthalmoplegic migraine: A rare type that often begins in childhood. Severe headache that can last for days, with associated weakness of one or more of the eye muscles that can persist for weeks.
WHAT CAUSES A MIGRAINE HEADACHE?
The cycle begins because of a spasm (tightening and narrowing) of arterial blood vessels somewhere in your brain; sometimes this produces an aura, sometimes not. After about 20-30 minutes the constricted vessels begin to dilate and stretch, creating an increase in blood flow. That is when the throbbing headache begins. (many people, especially women after menopause, experience only the aura and have no headache.)
The exact cause of what starts the cycle of vascular spasm/dilation is not known. Research has found a possible link to low levels of serotonin; a chemical in the brain. Low levels of serotonin may be related to emotional factors, tension and stress, fatigue, loud noises, glaring lights, certain drugs, alcohol, caffeine, or estrogen hormones, such as in oral contraceptives and hormone replacement therapy.
A wide variety of foods and additives can trigger migraines in some people: citrus fruit, chocolate, red wine, aged cheese, smoked meat and products containing nitrates, tyramine, or monosodium glutamate (MSG). Other triggers can be cigarette smoke, strong odors, sudden cold, or even a drop in atmospheric pressure-as in high altitudes, inside an airplane, or near an approaching storm.
EXAMINATION
If you think your headaches are migraines, chances are you are correct. The symptoms are often so recognizable that a diagnosis can be made from your history alone.
If your symptoms are not typical, if you your first migraine is after age 40, if you begin having auras with no subsequent headache, or if you have even a temporary loss of vision, you should have an eye exam, a general physical exam, and possibly a neurological exam to make sure you do not have a disease that causes symptoms that mimic those of migraine. These include vascular disease that produces TIAs (transient ischemic attacks), high blood pressure, and a particular type of glaucoma.
An eye exam would include evaluation of your vision, pupils, eye movement, retina and optic nerve. You may also have a visual field test to measure side vision, and tonnometry, to check the pressure with in your eyes. All of these tests are painless.
TREATMENT
First, think of prevention. Try to identify what might be triggering your attacks by keeping a log of when your headaches occur. Eliminate the possible triggers systematically. If you are taking any hormones, including birth control pills, the medication or its dosage may need to be changed. (Women who have migraines and use birth control pills or other estrogens may have a slightly increased risk of having a stroke. Check with your personal physician.)
Once the headache begins, a quiet, darkened room will help you feel better. You may be able to decrease the headaches severity by reducing blood flow to your head. Any of the following may help:
- Apply cold compresses to your head and neck
- Press your palms firmly against your temples
- Put your hand in hot (not burning) water
- Take a hot shower
- Lie down with your head higher then the rest of the body
Mild pain relievers such as aspirin, acetaminophen (Tylenol), or ibuprofen (Advil) are worth a try. At least they may help you get to sleep which often works to relieve the pain.
There are new prescription medications that may help. Some are taken at the first sign of an attack. Taken early enough, these can abort the attack or at least lessen the severity of the headache. Others, taken regularly for several months, may reduce the frequency of attacks. The effects of any medication will need to be carefully monitored.
Migraine headaches can be incapacitating, but they rarely indicate a serious disease or cause any permanent damage.
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